Provider Demographics
NPI:1033516398
Name:CREIGHTON-HEIN, CAROLYN JOY (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOY
Last Name:CREIGHTON-HEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:JOY
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:33113 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-8915
Mailing Address - Country:US
Mailing Address - Phone:360-903-1413
Mailing Address - Fax:360-835-5618
Practice Address - Street 1:5400 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7049
Practice Address - Country:US
Practice Address - Phone:360-903-1413
Practice Address - Fax:360-835-5618
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000051361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical